Brachytherapy Group Research Articles

Interstitial brachytherapy for penile carcinoma: a multicentric survey (259 patients)

Although cancer of the penis is a rare disease, we have collected 506 cases through a multicentric study. In the present study we analyse the results obtained from 259 patients treated by interstitial brachytherapy from 1959 to 1989. Among the 259 patients, 184 males had exclusive brachytherapy (group A) while 75 received a combination of surgery and brachytherapy and/or external beam irradiation (EBI) (group B). Five- and 10-year survival rates are, respectively: overall survival, 66 and 52%; cause-specific survival, 88 and 88%; disease-free survival, 78 and 67%. One hundred and forty-three patients in group A (78%) and 48 (64%) in group B avoided mutilation of the penis while late side effects occurred in 137 259 patients (53%). Survival depends on the volume of the tumor and the presence of involved nodes; systematic groin dissection does not however seem advisable.

Floor of the mouth cancer.

One hundred eighty-three patients with floor of the mouth cancer, of whom 162 were evaluable, were treated between 1962 and 1987. Most patients (139) received treatment with curative intent. Forty-seven received surgery only; 45 received radiotherapy (RT) only; 23 received preoperative RT and surgery; 24 received surgery and postoperative RT. A subset of 30 patients received brachytherapy and external beam RT. Overall survival rates were: surgery only, 90%/68% (2 years/5 years); RT only, 65%/45%; preoperative RT, 65%/43%; and postoperative RT, 78%/41%. Patients receiving surgery generally had lower stage disease and good performance status; RT patients generally had higher stage disease--(64% had stages III and IV disease). Patients receiving RT also had over twice the incidence of deaths from intercurrent disease. These were the contributing factors to the lower survival rate of the patients receiving RT. Disease-free survivals were similar between the groups. In contrast, locoregional control was better for patients receiving RT, particularly in the postoperative RT and brachytherapy groups. Locoregional control rates were: surgery only, 59%/52% (2 years/5 years); RT only, 78%/69%; preoperative RT, 75%/58%; postoperative RT, 80%/74%; and brachytherapy, 96%/89%. This advantage in locoregional control was marked in patients with advanced local disease and was evident at 2 years and beyond. Treatment approaches evolved during the study period toward the use of surgery only in lower stages and combined with RT (usually postoperative) in higher stages.

Long-term results of a prospective randomized trial of adjuvant brachytherapy in the management of completely resected soft tissue sarcomas of the extremity and superficial trunk

Purpose : A prospective randomized trial evaluating adjuvant brachytherapy for soft tissue sarcomas was conducted between July 1982 and July 1987. Methods and Materials : One hundred twenty-six patients with soft tissue sarcoma of the extremity or superfacial trunk (STS) underwent grossly complete resection with limb-sparing surgery. Intra-operatively, patients were randomized to receive either adjuvant brachytherapy (BRT) or no further therapy (no BRT). BRT consisted of an Iridium-192 implant which delivered 4200–4500 cGy over 4–6 days. Total hospital stay for combined surgery and BRT was 10–14 days. Patients in each group were well matched with respect to age, sex, site, tumor size, depth, histologic type, and grade. Median follow-up is 665 months for all living patients. Results : At 5 years, local control was 82% in the BRT group vs. 67% in the no BRT group ( p = .049). When analyzed by histologic grade, high grade tumors had local control of 90% with BRT vs. 65% with no BRT ( p = .013). There was no difference in local control in the low grade patients in either arm. At 5 years, the proportion free of distant metastases was approximately 76% in both arms, with no difference between BRT and no BRT. When analyzed by grade, high grade patients had a similar proportion free of distant metastasis in the BRT vs. no BRT arms despite improved local control in those receiving BRT. Similarly, the disease-specific survival for all patients at 5 years was 81% for BRT vs. 80% for no BRT ( p = NS). When analyzed by grade, and treatment (BRT vs. no BRT), 5-year disease-specific survival for high grade was the same in both groups. Conclusions : Adjuvant BRT significantly improves local control in completely resected STS. This improvement is confined to patients with high grade histology. BRT provides excellent local control in this group, and significantly shortens the treatment time when compared to adjuvant external beam radiation. However, the improved local control does not translate into either decreased distant metastasis or increased disease-specific survival.

Prospective randomized clinical trial comparing brachytherapy and laser photoablation for palliation of esophageal cancer

Twenty-three consecutive patients with advanced esophageal cancer were randomized to receive either endoluminal irradiation or laser photoablation treatment. Initial improvement in dysphagia scores was observed in 83% (brachytherapy) and 91% (laser). This improvement in dysphagia was maintained at 2 months in 75% (brachytherapy) and 81% (laser). Performance scores improved in 33% (brachytherapy) and 36% (laser). Both treatments were well tolerated, required a minimum of inpatient treatment time, and allowed patients to die without terminal admission to district referral centers. Retreatments were three times as common with laser therapy, but the frequency of treatment failures was equal. Minor complications, especially transient early dysphagia, was more common in the brachytherapy group, although the only major complication (perforation) occurred in the laser group. No procedure-related deaths occurred in either group.

Iridium-192 brachytherapy in the management of 147 T 2N 0 oral tongue carcinomas treated with irradiation alone: comparison of two treatment techniques

Our purpose is to analyse local control, complications relative to the proportion of total dose delivered by external beam irradiation versus interstitial implant in 147 patients with previously untreated T2N0 squamous cell carcinoma of the oral tongue, managed between 1973 and 1986 (UICC staging system). These T2N0 patients are part of a larger group of 430 patients with oral tongue carcinoma (T1, T2, T3) treated with irradiation alone. Of these 147 T2N0 patients, 70 were treated with interstitial implant alone and 77 with both external beam irradiation and implant. In the group treated with interstitial implant alone, the 5-year local control was 89.8% against 50.6% in those treated with external beam irradiation and interstitial implant (log-rank test, p = 0.00002); 67.6% versus 46.5% for locoregional control (p = 0.029); and 62.2% versus 34.7% for specific survival (p = 0.0015). Since 1980, all the patients treated by iridium implantation were protected with a leaded spacing device between the tongue and the mandible. Soft tissue necrosis and bone exposure following treatment were scored according to the following criteria: minor, moderate or severe. Seven moderate and one severe complications were recorded in the brachytherapy group. None of the patients required surgery. In the combined treatment group, six moderate and two severe complications were observed. Patients treated with interstitial implant alone, and showing moderate or severe complications had received an average brachytherapy dose of 7600 cGy. In the same group, the patients without complications had received an average dose of 6800 cGy.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonic Tissue Characterization of Uveal Melanoma and Prediction of Patient Survival After Enucleation and Brachytherapy

We performed survival studies on 136 patients with uveal malignant melanoma who were examined with ultrasonic tissue characterization before treatment with cobalt-60 brachytherapy (74 patients) or enucleation (62 patients). Mean follow-up time was 58.7 months for the brachytherapy group and 59.0 months for the enucleated group. The maximal follow-up time was nearly ten years. Univariate survival analysis showed that patients with small tumors (less than 250 mm3, 49 patients) had a higher five-year survival when treated with brachytherapy than when treated with enucleation. No patients in this study with tumor volumes greater than 1,500 mm3 (13 patients) were treated with brachytherapy. For tumors of intermediate size (74 patients), survival analysis did not indicate appreciable differences between the treatment options. However, multivariate models including two ultrasonic tissue characterization variables, scatterer size and concentration, showed appreciable intergroup differences in the dependence of survival on these factors. Results suggest that tissue properties detectable with ultrasonic techniques are related to differences in patient survival and may be used for treatment planning for tumors of intermediate size.

Preoperative or postoperative brachytherapy for patients with endometrial carcinoma stage I and II

In endometrial carcinoma, vaginal vault brachytherapy is performed to improve the local control rate and to decrease vaginal recurrences. To assess the best chronology of this brachytherapy compared to surgery, we have retrospectively analyzed results of treatment of patients treated either with preoperative brachytherapy (60 Gy) and then radical hysterectomy with bilateral salpingo oophorectomy (RH-BSO) (Group 1), or with RH-BSO and then postoperative brachytherapy (60 Gy) (Group 2). There were one hundred twenty-one patients in Group 1 and 63 in Group 2. The mean age was 61.8 years in Group 1 and 64.3 in Group 2. In Group 1, 73% of the patients were Stage I, and 77.6% were in Group 2. The two groups were comparable for histological grading and depth of tumoral invasion into the myometrium. Brachytherapy was delivered with one uterine and two vaginal sources in Group 1 and with three vaginal sources in Group 2. Doses to the reference volume and to reference points were calculated according to ICRU recommendations. Brachytherapy data were similar in the two groups except reference volume, which was smaller in Group 2. Local control rate was 87% in Group 1 and 91% in Group 2. Distant metastasis occurred in 12% of patients in Group 1 and 9% in Group 2. The 5-year actuarial survival rate was 84% in Group 1 and 89% in Group 2. Regarding stage, histological grading, and depth of tumoral invasion, no differences were observed between the two therapeutic groups. The only prognostic factor in the entire population was Stage. The 5-year actuarial survival rate was 91% for Stage I patients and 69% for Stage II ( p value < 0.03). The late severe complication rate was 14% in Group 1 and 7.9% in Group 2, a difference which was not statistically significant. We concluded that since no differences were observed between the two techniques, vaginal brachytherapy should be performed postoperatively when surgery is the first treatment (Stage I or II, grade 1 or 2, and no deep tumoral invasion into the myometrium).